Section 27-20.10-1. – Definitions.
§ 27-20.10-1. Definitions. For purposes of this chapter, the following definitions shall apply: (1) “Contracting entity” means any person or entity that enters into direct contracts with providers for the delivery of healthcare services in the ordinary course of business. (2) “Control” and “under common control with” shall mean possession, directly or indirectly, of the […]
Section 27-20.10-2. – Scope.
§ 27-20.10-2. Scope. (a) This chapter shall apply to health insurance corporations subject to chapter 1 of this title, nonprofit hospital or medical service corporations subject to chapters 19 or 20 of this title, and health maintenance organizations incorporated or resident in the state of Rhode Island. (b) This chapter shall not apply to provider […]
Section 27-20.10-3. – Registration.
§ 27-20.10-3. Registration. (a) Any person that commences business as a contracting entity shall register with the department within thirty (30) days of commencing business in the state of Rhode Island unless such person is licensed by the department as an insurer. Upon passage of this chapter, each person not licensed by the department as […]
Section 27-20.10-4. – Contracting entity rights and responsibilities.
§ 27-20.10-4. Contracting entity rights and responsibilities. (a) A contracting entity may not grant access to a provider’s healthcare services and contractual discounts pursuant to a provider network contract unless: (1) The provider network contract specifically states that the contracting entity may enter into an agreement with a third-party allowing the third-party to obtain the […]
Section 27-20.10-5. – Third-party rights and responsibilities.
§ 27-20.10-5. Third-party rights and responsibilities. (a) A third-party, having itself been granted access to a provider’s healthcare services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third-party is obligated to comply with the rights and responsibilities imposed on contracting entities under §§ 27-20.10-4 and 27-20.10-6. (b) A […]
Section 27-20.10-6. – Unauthorized access to provider network contracts.
§ 27-20.10-6. Unauthorized access to provider network contracts. (a) It is an unfair insurance practice for the purposes of chapter 29 of this title to knowingly access or utilize a provider’s contractual discount pursuant to a provider network contract without a contractual relationship with the provider, contracting entity, or third-party, as specified in this chapter; […]
Section 27-20.10-7. – Enforcement.
§ 27-20.10-7. Enforcement. Enforcement of this model will follow that of chapter 29 of this title, “Unfair Competition and Practices.” History of Section.P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.